Clinical evaluation of a mobile, low-cost system for fluorescence guided photodynamic therapy of early oral cancer in India.

Autor: Siddiqui SA; Aligarh Muslim University, Jawaharlal Nehru Medical College, Department of Radiotherapy, Aligarh, India., Siddiqui S; Aligarh Muslim University, Jawaharlal Nehru Medical College, Department of Radiodiagnosis, Aligarh, India., Hussain MAB; Aligarh Muslim University, Jawaharlal Nehru Medical College, Department of Radiotherapy, Aligarh, India., Khan S; Aligarh Muslim University, Jawaharlal Nehru Medical College, Department of Radiotherapy, Aligarh, India; University of Massachusetts at Boston, Boston, MA, United States; Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States., Liu H; University of Massachusetts at Boston, Boston, MA, United States., Akhtar K; Aligarh Muslim University, Jawaharlal Nehru Medical College, Department of Pathology, Aligarh, India., Hasan SA; Aligarh Muslim University, Jawaharlal Nehru Medical College, Department of Otorhinolaryngology (E.N.T.), Aligarh, India., Ahmed I; Aligarh Muslim University, Jawaharlal Nehru Medical College, Department of Radiodiagnosis, Aligarh, India., Mallidi S; Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States., Khan AP; Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States., Cuckov F; Wentworth Institute of Technology, Boston, Massachusetts, United States., Hopper C; University College London, England., Bown S; University College London, England., Celli JP; University of Massachusetts at Boston, Boston, MA, United States; Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States., Hasan T; Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States; Division of Health Sciences and Technology, Harvard University and Massachusetts Institute of Technology, Cambridge, MA, USA. Electronic address: thasan@mgh.harvard.edu.
Jazyk: angličtina
Zdroj: Photodiagnosis and photodynamic therapy [Photodiagnosis Photodyn Ther] 2022 Jun; Vol. 38, pp. 102843. Date of Electronic Publication: 2022 Mar 31.
DOI: 10.1016/j.pdpdt.2022.102843
Abstrakt: Background: Morbidity and mortality due to oral cancer in India are exacerbated by a lack of access to effective treatments amongst medically underserved populations. We developed a user-friendly low-cost, portable fibre-coupled LED system for photodynamic therapy (PDT) of early oral lesions, using a smartphone fluorescence imaging device for treatment guidance, and 3D printed fibreoptic attachments for ergonomic intraoral light delivery.
Methods: 30 patients with T 1 N 0 M 0 buccal mucosal cancer were recruited from the JN Medical College clinics, Aligarh, and rural screening camps. Tumour limits were defined by external ultrasound (US), white light photos and increased tumour fluorescence after oral administration of the photosensitising agent ALA (60 mg/kg, divided doses), monitored by a smartphone fluorescence imaging device. 100 J/cm 2 LED light (635 nm peak) was delivered followed by repeat fluorescence to assess photobleaching. US and biopsy were repeated after 7-17 days. This trial is registered with ClinicalTrials.gov, NCT03638622, and the study has been completed.
Findings: There were no significant complications or discomfort. No sedation was required. No residual disease was detected in 22 out of 30 patients who completed the study (26 of 34 lesions, 76% complete tumour response, 50 weeks median follow-up) with up to 7.2 mm depth of necrosis. Treatment failures were attributed to large tumour size and/or inadequate light delivery (documented by limited photobleaching). Moderately differentiated lesions were more responsive than well-differentiated cancers.
Interpretation: This simple and low-cost adaptation of fluorescenceguided PDT is effective for treatment of early-stage malignant oral lesions and may have implications in global health.
(Copyright © 2022 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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